Provider Demographics
NPI:1790894590
Name:HOM, BARNEY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:BARNEY
Middle Name:M
Last Name:HOM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S SEPULVEDA BLVD
Mailing Address - Street 2:#216
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266
Mailing Address - Country:US
Mailing Address - Phone:310-376-8725
Mailing Address - Fax:310-376-8726
Practice Address - Street 1:500 S SEPULVEDA BLVD
Practice Address - Street 2:#216
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266
Practice Address - Country:US
Practice Address - Phone:310-376-8725
Practice Address - Fax:310-376-8726
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26999122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist